Protecting young athletes from concussions

What do ballet dance, football, hockey, soccer and rugby all have in common?

Answer: Participants in each of those activities can be at risk of suffering a concussion.

“Children who play sports with a high collision rate have a higher risk of sustaining a concussion, but it can happen in any sport,” says Dr. Farah Tejpar, a sports medicine specialist with Cleveland Clinic Florida.

While we associate concussions more commonly with high-contact sports like football and hockey, a kick to the head or upper body from a dance partner can result in a concussion, similar to being tackled in football or heading a soccer ball.

“Any impact to the head, neck or body with a force that results in the rotation of the brain can cause a concussion,” says Dr. Matthew L. Fazekas, a pediatric sports medicine physician at Joe DiMaggio Children’s Hospital in Hollywood.

That may understandably make parents reluctant to let their children play sports.

One in five young athletes will suffer a concussion during a season. According to the National Athletic Trainers’ Association, more than 50 percent of all emergency room visits by children ages 8 through 13 were for sports-related concussions.

According to the Centers for Disease Control (CDC), approximately 3.8 million concussions were reported in 2012, double the number from 10 years earlier. Part of the reason for the increase could include more young athletes being involved in organized sports, and better awareness and reporting of the symptoms of concussions.

“The definition and symptoms have not changed, but we are more aware of what happens to young athletes when they get hit on the field,” Dr. Fazekas says.

As defined by the CDC, a concussion is caused by a blow, bump or jolt to the head or hit to the body that causes the head and brain to move rapidly back and forth. That sudden acceleration or deceleration can cause the brain to bounce around or rotate in the skull, stretching and damaging brain cells and causing chemical changes in the brain.

The more proper medical name for a concussion is “mild traumatic brain injury.” As with any brain injury, it needs to be taken seriously.

“There is still a lot we don’t know about concussions,” Dr. Fazekas points out. “Like why some athletes feel better 24 hours after [experiencing post-concussion symptoms] and some others three months after. Why younger athletes have longer-term symptoms than adults.”

One of the things the medical community does know is that female athletes are at significantly higher risk of sustaining a concussion than males when playing similar sports, such as soccer and basketball.

For instance, some studies show that girls who play soccer suffer concussions 68 percent more often than boys playing the same sport. Plus, girls have almost three times the concussion rate as boys when playing high-school basketball.

In addition, Dr. Tejpar notes, girls “take much longer than boys to have symptoms resolved.”

One theory, he suggests, is that girls have less developed neck muscles. Which means their necks absorb less of the shock from a hit. “As a result, the head whips around a lot more,” he explains.

Among other theories suggested by medical experts: that girls have less developed core muscles and smaller heads, have hormonal differences that may exacerbate brain injuries and blood flow rates to brain and possibly intensify post-concussion symptoms, and that girls simply tend to self-report feelings of symptoms more often than boys.

Although an athlete who has suffered a concussion “has two to five times higher risk of getting [another] concussion,” says Dr. Tejpar, it does not mean the athlete is in danger of suffering permanent brain damage. Multiple concussions may increase that danger, but a single concussion should not.

“If [a concussion] is recognized early and treated properly, the athlete can be completely safe,” Dr. Tejpar notes.

So, how do we protect young athletes from concussions?

“There is nothing currently on the market that can prevent concussions,” Dr. Fazekas observes. “So, you have to look at risk reduction. Helmets have been shown to prevent bleeding in the brain and traumatic brain injury.

“In terms of risk reduction, [one possibility is] strengthening the neck, chest and upper body muscles. Also, utilizing proper techniques in things like tackling in football and heading the ball in soccer.”

Other suggestions include making sure players wear appropriate and properly fitted safety gear, that players follow and officials enforce the rules of play, and that coaches are knowledgeable and vigilant about post-concussion symptoms.

“Some games are going to have to change,” Dr. Kuluz suggests.

For instance, no heading balls in soccer; and in football, limited tackling drills during practice or no spear tackling (where a player launches his body like a spear – head out and arms by their side – against an opponent).

“And there is a big debate going on about girls wearing helmets in lacrosse,” Dr. Kuluz notes. In many areas of the country, boys are required to wear helmets in lacrosse, but girls are not.

For parents who may be reluctant to let their children play sports for fear of sustaining a concussion, Dr. Kuluz recommends they make a pact with their children.

“Tell them, ‘I will approve you playing, but there are conditions. One is, you have to promise that if you hit your head on the ground or you get hit in the head or if you [experience symptoms of a concussion] you have to pull yourself out of the game. If you can’t do that, you can’t play.’

“Tell them, ’No matter what injury you have – a knee, finger, ankle – I want to know about it, so I can help you get healthy.’”